St. John's Wort

A genus of over 400 species of annuals, herbaceous perennials, and deciduous, semi-evergreen, and evergreen shrubs and trees, found mainly in temperate regions. This varied group provides many fine garden plants for most settings. Hypericum perforatum is a good subject for a wildflower meadow or woodland area. Hypericum may derive from the Greek hyper, "above", and eikon, "picture", since the flowers were placed above religious images to keep off evil at the northern Midsummer Day (June 24, St. John's Day). The alleged magical properties of H. perforatum were partly due to hypericin, the fluorescent red pigment that oozes like blood from the crushed flowers. As a medicinal herb, St. John's wort was traditionally used internally to treat nervous complaints and externally for healing, but fell into disuse int he 19th century. During the late 20th century, it underwent a revival following clinical trials that demonstrated its effectiveness in relieving mild to moderate depression and was described as "nature's Prozac". St. John's wort contains hypericin and hyperforin, which have anti-depressant effect; adhyperforin, which promotes wound healing; and also proanthocyanidins that benefit circulation. Standardized herbal preparations are graded according to their hypericin content, though other constituents may have an important role to play in the overall effect. St. John's wort is also a potent anti-viral and has potential in the development of drugs for treating human immuno-deficiency virus (HIV), viral hepatitis, and chronic fatigue syndrome. Synthetic hypericin is being developed as an antiretroviral agent for blood transfusions.

Named for St. John, the patron saint of nurses, this herb in medieval times was believed to br such a powerful healer that if people put a cutting of it under their pillow on St. John's Eve, St. John himself would appear in their dreams and ward off death for another year. The herb's scientific name, Hypericum, comes from the Greek word meaning "over an apparition", referring to the herb's purported ability to make evil spirits fly away with just one whiff of its pungent odor.

Named for John the Baptist, as the story goes, St. John's Wort is a centuries old infection fighter and wound healer. Recent research has shown that the restorative power of this herbs even extends to mild states of depression, insomnia, sciatica, ulcers and viral infections, including HIV.

Throughout the Middle Ages, St. John's wort was believed to banish evil spirits. The herb was placed in windows to keep demons from entering.

A member of the Clusiaceae family, St. John's Wort is a fragrant and hardy herb that can grow to a height of 40 inches. Its lemon-scented, star-shaped yellow flowers bloom in summer and early autumn. The leaves of St. John's wort appear perforated when held up to the sun; these "holes" are actually transparent oil glands.

Upright, clump-forming perennial, woody at the base, with blunt, oblong-elliptic to linear leaves, 3cm (1¼in) long. Yellow, 5-petaled, gland-dotted flowers, 2cm (¾in) across, appear in large cymes in summer.

Common Name:	St. John's Wort
Other Names:	Amber, Common St. John's Wort, Goatweed, Hardhay, Klamath Weed, Perforate St. John's Wort, Tipton Weed.
Botanical Name:	Hypericum perforatum
Genus:	Hypericum
Family:	Guttiferae
Native Location:	Europe, W Asia Indigenous to Europe, St. John's Wort now grows wild throughout much of the world, and can be found in meadows, along riverbanks and by roadsides. Cultivation of the herb has surged in recent years, due to its value as a sedative, antidepressant and expectorant.
Cultivation:	Well-drained to dry soil in sun or partial shade.
Propagation:	By seed sown in autumn; by division in autumn or spring. Self-seeds readily. Subject to statutory control as a weed in some countries, notably in Australia.
Harvest:	Plants are cut as flowering begins and used fresh or dried in creams, infusions, liquid extracts, medicated oils, and tinctures.
Height:	60cm-1m (2-3ft)
Width:	45-60cm (18-24in)
Hardiness:	Z4-8
Parts Used:	Whole plant, flower, bud The flowers and 3-4 inches of the leafy stem are picked at midsummer for medicinal use.
Components:	The key compound responsible for St. John's wort's antidepressant and antiviral properties is hypericin, found in the herb's flowers and flower buds. It also contains hyperforin, and antibiotic and anticarcinogenic bitter principle found in the leaves. Other constituents include an essential oil and flavonoids.
Properties:	A bitter-sweet, cooling herb that is astringent, calms the nerves, reduces inflammation, and promotes healing. Locally antiseptic and analgesic.
Indications:	St. John's Wort can be taken internally as a tea, tincture or infusion to remedy colds, migraines, stomach ailments, insomnia, and depression. (If you suffer from severe depression, consult a health-care professional.) The herb may be used topically, as well to treat hemorrhoids, wounds and burns and to relieve cramps and nerve pain.
Medicinal Uses:	Internally for anxiety, mild to moderate depression, nervous tension, insomnia, enuresis (especially in children), menopausal disturbances, premenstrual syndrome, shingles, sciatica, and fribrositis. Not given to patients suffering from severe depression. Contraindicated with the following medications: oral contraceptives; warfarin; digoxin; anticonvulsants; theophylline; selective serotonin re-uptake inhibitors (SSRIs); triptans; cyclosporin; and with various anti-virals prescribed for HIV patients. Externally for bruises, injuries (especially deep or painful wounds involving nerve damage), sores, sciatica, neuralgia, cramps, sprains, and tennis elbow. Works well with Calendula officinalis (See, pot marigold) or Hamamelis virginiana (See, common witch hazel) for bruises. Used in homeopathy for pain and inflammation caused by nerve damage. To treat depression, anxiety, worm infestation, asthma, gout, rheumatism, and burns. Germany's Commission E has approved the use of St. John's wort to treat anxiety, depressive moods, blunt injuries, inflammation of the skin, wounds, and burns.
Methods of Administration:	Tea For colds or flu, pour 1 cup of boiling water over 2 tsp. of fresh, flowering tops. Steep for 10 min. and strain. Drink 1 cup 2-3 times a day. Tincture For depression, combine 1/2 cup of fresh, flowering tops, with 1 cup of vodka or brandy. Steep for 4-6 weeks, shaking often. Strain. Store the liquid in a glass bottle. Use 40-80 drops, 3 times daily, up to 6 months. The mood alterring effects of St. John's wort should be noticeable after 3 weeks. Infused oil Infusions of St. John's wort oil are available at health food stores. For a stomachache, take 1 tsp. 2-3 times daily. The infused oil may also be added to salad dressings. Salve Salves made from St. John's wort can be purchased at health food stores. Apply the salve liberally as needed throughout the day to hemorrhoids and slow-healing wounds.
Typical Dose:	A typical dose of St. John's wort in tablet/capsule form is approximately 300 mg Hypericum extract (standardized to 0.3 percent hypericin) taken three times daily.
Possible Side Effects:	St. John's wort's side effects include dizziness, fatigue, restlessness, insomnia, constipation, and photosensitivity.
Drug Interactions:	Taking St. John's wort with these drugs may increase the risk of bleeding or bruising: Antithrombin III, (Thrombate III) Argatroban, (Argatroban) Bivalirudin, (Angiomax) Dalteparin, (Fragmin) Danaparoid, (Orgaran) Enoxaparin, (Lovenox) Fondaparinux, (Arixtra) Heparin, (Hepalean, Hep-Lock) Lepirudin, (Refludan) Tinzaparin, (Innohep) Warfarin, (Coumadin, Jantoven) Taking St. John's wort with these drugs may increase the risk of hypoglycemia (low blood sugar): Acarbose, (Prandase, Precose) Acetohexamide, (Acetohexamide) Chlorpropamide, (Diabinese, Novo-Propamide) Gliclazide, (Diamicron, Novo-Gliclazide) Glimepiride, (Amaryl) Glipizide, (Glucotrol) Glipizide and Metformin, (Metaglip) Gliquidone, (Beglynor, Glurenorm) Glyburide, (DiaBeta, Micronase) Glyburide and Metformin, (Glucovance) Insulin, (Humulin, Novolin R) Metformin, (Glucophage, Riomet) Miglitol, (Glyset) Nateglinide, (Starlix) Pioglitazone, (Actos) Repaglinide, (GlucoNorm, Prandin) Rosiglitazone, (Avandia) Rosiglitazone and Metformin, (Avandamet) Tolazamide, (Tolinase) Tolbutamide, (Apo-Tolbutamide, Tol-Tab) Taking St. John's wort with these drugs may interfere with the effectiveness of the drug: Acebutolol, (Novo-Acebutolol, Sectral) Alprazolam, (Apo-Alpraz, Xanax) Amlodipine, (Norvasc) Amobarbital, (Amytal) Amobarbital and Secobarbital, (Tuinal) Amprenavir, (Agenerase) Antithymocyte Globulin, Equine, (Atgam) Antithymocyte Globulin, Rabbit, (Thymoglobulin) Atenolol, (Apo-Atenol, Tenormin) Atorvastin, (Lipitor) Azathioprine, (Imuran) Basiliximab, (Simulect) Befunolol, (Bentos, Betaclar) Bepridil, (Vascor) Betaxolol, (Betoptic S, Kerlone) Bisoprolol, (Monocor, Zebeta) Bromazepam, (Apo-Bromazepam, Gen-Bromazepam) Brotizolam, (Lendorm, Sintonal) Butabarbital, (Butisol Sodium) Butalbital, Acetaminophen, and Caffeine, (Esgic, fioricet) Butalbital, Aspirin, and Caffeine, (Fiorinal) Carteolol, (Cartrol, Ocupress) Carvedilol, (Coreg) Celiprolol, (Celiprolol) Chlordiazepoxide, (Apo-Chlordiazepoxide, Librium) Chlorzoxazone, (Strifon Forte) Clobazam, (Alti-Clobazam, Frisium) Clonazepam, (Klonopin, Rivotril) Clorazepate, (Tranxene, T-Tab) Clozapine, (Clozaril, Gen-Clozapine) Cyclophosphamide, (Cytoxan, Neosar) Cyclosporine, (Neoral, Sandimmune) Cyproterone and Ethinyl Estradiol, (Diane-35) Daclizumab, (Zenapax) Delavirdine, (Rescriptor) Diazepam, (Apo-Diazepam, valium) Diltiazem, (Cardizem, Tiazac) Efalizumab, (Raptiva) Efavirenz, (Sustiva) Esmolol, (Brevibloc) Estazolam, (ProSom) Estradiol, (Climara, Estrace) Estradiol and Medroxyprogesterone, (Lunelle) Estradiol and Norethindrone, (Activella, CombiPatch) Estradiol and Testosterone, (Climacterone) Estrogens (Conjugated A/Synthetic)(Cenestin) Estrogens (Conjugated/Equine), (Congest, Premarin) Estrogens (Conjugated/Equine) and Medroxyprogesterone, (Premphase, Prempro) Estrogens (Esterified), (Estratab, Menest) Estrogens (Esterified) ande Methyltestosterone, (Estratest, Estratest H.S.) Estropipate, (Ogen, OrthoEst) Ethinyl Estradiol, (Estinyl) Ethinyl Estradiol and Desogestrel, (Cyclessa, Ortho-Cept) Ethinyl Estradiol and Drospirenone, (Yasmin) Ethinyl Estradiol and Ethynodiol Diacetate, (Demulen, Zovia) Ethinyl Estradiol and Etonogestrel, (NuvaRing) Ethinyl Estradiol and Levonorgestrel, (Alesse, Triphasil) Ethinyl Estradiol and Norelgestromin, (Evra, Ortho Evra) Ethinyl Estradiol and Norethindrone, (Brevicon, Ortho-Novum) Ethinyl Estradiol and Norgestrel, (Cryselle, Ovral) Etoposide, (Toposar, VePesid) Felodipine, (Plendil, Renedil) Flurazepam, (Apo-Flurazepam, Dalmane) Fluvastatin, (Lescol) Imatinib, (Gleevec) Indinavir, (Crixivan) Irinotican, (Camptosar) Isradipine, (DynaCirc) Labetalol, (Normodyne, Trandate) Lacidipine, (Aponil, Caldine) Lercanidipine, (Cardiovasc, Carmen) Levobetaxolol, (Betaxon) Levobunolol, (Betagan, Novo-Levobunolol) Levonorgestrel, (Levonorgestrel) Lopinavir and Ritonavir, (Kaletra) Loprazolam, (Dormonoct, Havlane) Lorazepam, (Ativan, Nu-Loraz) Lovastatin, (Altocor, Mevacor) Manidipine, (Calslot, Iperten) Medroxyprogesterone, (Depo-Provera, Provera) Mephobarbital, (Mebaral) Mestranol and Norethindrone, (Necon 1/50, Ortho-Novum 1/50) Methohexital, (Brevital, Brevital Sodium) Methotrexate, (Rheumatrex, Trexall) Metipranolol, (Optipranolol) Metoprolol, (Betaloc, Lopressor) Midazolam, (Apo-Midazolam, Versed) Muromonab-CD2, (Orthoclone OKT 3) Mycophenolate, (CellCept) Nadolol, (Apo-Nadol, Corgard) Nelfinavir, (Viracept) Nevirapine, (Viramune) Nicardipine, (Cardene) Nifedipine, (Adalat CC, Procardia) Nilvadipine, (Nilvadipine) Nimodipine, (Nimotop) Nisoldipine, (Sular) Nitrendipine, (Nitrendipine) Norgestrel, (Ovrette) Oxazepam, (Novoxapam, Serax) Oxprenolol, (Slow-Trasicor, Trasicor) Paclitaxel, (Onzol, Taxol) Pentobarbital, (Nembutal) Phenobarbital, (Luminal Sodium, PMS-Phenobarbital) Phenytoin, (Dilantin, Phenytek) Pimecrolimus, (Elidel) Pinaverium, (Dicetel) Pindolol, (Apo-Pindol, Novo-Pindol) Polyestradiol, (Polyestradiol) Pravastatin, (Novo-Pravastatin, Pravachol) Prazepam, (Prazepam) Primidone, (Apo-Primidone, Mysoline) Propranolol, (Inderal, InnoPran XL) Quazepam, (Doral) Reserpine, (Reserpine) Ritonavir, (Norvir) Rosuvastatin, (Crestor) Saquinavir, (Fortovase, Invirase) Secobarbital, (Seconal) Simvastatin, (Apo-Simvastatin, Zocor) Sirolimus, (Rapamune) Sotalol, (Betapace, Sorine) Tacrolimus, (Prograf, Protopic) Tamoxifen, (Nolvadex, Tamofen) Temazepam, (Novo-Temazepam, Restoril) Tetrazepam, (Mobiforton, Musapam) Thalidomide, (Thalomid) Theophylline, (Elixophyllin, Uniphyl) Thiopental, (Pentothal) Timolol, (Betimol) Triazolam, (Apo-Triazo, Halcion) Verapamil, (Calan, Isoptin SR) Taking St. John's wort with these drugs may interfere with the absorption of the drug: Ferric Gluconate, (Ferrlecit) Ferrous Fumarate, (Femiron, Feostat) Ferrous Gluconate (Fergon, Novo-Ferrogluc) Ferrous Sulfate, (Feratab, Fer-Iron) Ferrous Sulfate and Ascorbic Acid, (FeroGrad 500, Vitelle Irospan) Iron-Dextran Complex, (Dexferrum, INFeD) Polysaccharide-Iron Complex, (Hytinic, Niferex) Taking St. John's wort with these drugs may cause or increase serotonin syndrome (symptoms of which include agitation, rapid heart rate, flushing, heavy sweating, and possibly even death): Amitriptyline, (Elavil, Levate) Amitriptyline and Chlordiazepoxide, (Limbitrol) Amitriptyline and Perphenazine, (Etrafor, Triavil) Amoxapine, (Asendin) Buspirone, (BuSpar, Nu-Buspirone) Citalopram, (Celexa) Clomipramine, (Anafranil, Novo-Clopramine) Desipramine, (Alti-Desipramine, Norpramin) Dextroamphetamine, (Dexedrine, Dextrostat) Dextroamphetamine and Amphetamine, (Adderall, Adderall XR) Doxepin, (Sinequan, Zonalon) Fluoxetine, (Prozac, Sarafem) Fluvoxamine, (Alti-Fluvoxamine, Luvox) Imipramine, (Apo-Imipramine, Tofranil) Iproniazid, (Marsilid) Lofepramine, (Feprapax, Gamanil) Melitracen, (Dixeran) Methamphetamine, (Desoxyn) Moclobemide, (Alti-Moclobemide, Nu-Moclobemide) Nefazodone, (Serzone) Nortriptyline, (Aventyl HCl, Pamelor) Paroxetine, (Paxil) Phenelzine, (Nardil) Protriptyline, (Vivactil) S-Citalopram, (Lexapro) Selegiline, (Eldepryl) Sertraline, (Apo-Sertraline, Zoloft) Tranylcypromine, (Parnate) Trazodone, (Desyrel, Novo-Trazodone) Trimipramine, (Apo-Trimip, Surmontil) Venlafaxine, (Effexor) Taking St. John's wort with these drugs may increase the therapeutic and/or adverse effects of the drug: Almotriptan, (Axert) Eletriptan, (Relpax) Frovatriptan, (Frova) Taking St. John's wort with these drugs may increase skin sensitivity to sunlight: Acemetacin, (Acemetacin Heumann, Acemetacin Sandoz) Acetohexamide, (Acetohexamide) Aminolevulinic Acid, (Levulan Kerastick) Aspirin, (Bufferin, Ecotrin) Azosemide, (Diat) Benazepril, (Lotensin) Bumetanide, (Bumex, Burinex) Captopril, (Capoten, Novo-Captopril) Celecoxib, (Celebrex) Chlorothiazide, (Diuril) Chlorpropamide, (Diabinese, Novo-Propramide) Choline Magnesium Trisalicylate, (Trilisate) Choline Salicylate, (Teejel) Cilazapril, (Inhibace) Delapril, (Adecut, Delakete) Demeclocycline, (Declomycin) Diclofenac, (Cataflam, Voltaren) Diflunisal, (Apo-Diflunisal, Dolobid) Dipyrone, (Analgina, Dinador) Doxycycline, (Apo-Doxy, Vibramycin) Enalapril, (Vasotec) Erythromycin and Sulfisoxazole, (Eryzole, Pediazole) Ethacrynic Acid, (Edecrin) Etodolac, (Lodine, Utradol) Etorcoxib, (Arcoxia) Etozolin, (Elkapin) Fenoprofen, (Nalfon) Flurbiprofen, (Ansaid, Ocufen) Fosinopril, (Monopril) Furosemide, (Apo-Furosemide, Lasix) Glimepiride, (Amaryl) Glipizide, (Glucotrol) Glyburide, (DiaBeta, Micronase) Hydrochlorothiazide, (Apo-Hydro, Microzide) Hydrochlorothiazide and Triamterene, (Dyazide, Maxzide) Hydroflumethiazide, (Diucardin, Saluron) Ibuprofen, (Advil, Motrin) Imidapril, (Novarok, Tanatril) Indomethacin, (Indocin, Novo-Methacin) Ketoprofen, (Orudis, Rhodis) Ketorolac, (Acular, Toradol) Lisinopril, (Prinivil, Zestril) Magnesium Salicylate, (Doan's, Mobidin) Meclofenamate, (Meclomen) Mefenamic Acid, (Ponstan, Ponstel) Meloxicam, (MOBIC, Mobicox) Methyclothiazide, (Aquatensen, Enduron) Minocycline, (Dynacin, Minocin) Moexipril, (Univasc) Nabumetone, (Apo-Nabumetone, Relafen) Naproxen, (Aleve, Naprosyn) Niflumic Acid, (Niflam, Nifluril) Nimesulide, (Areuma, Aulin) Olmesartan and Hydrochlorothiazide, (Benicar HCT) Oxaprozin, (Apo-Oxaprozin, Daypro) Oxytetracycline, (Terramycin, Terramycin IM) Perindopril Erbumine, (Aceon, Coversyl) Piroxicam, (Feldene, Nu-Pirox) Polythiazide, (Renese) Quinapril, (Accupril) Ramipril, (Altace) Rofecoxib, (Vioxx) Salsalate, (Amgesic, Salflex) Spirapril, (Spirapril) Sulfacetamide, (Bleph-10, Klaron) Sulfadiazine, (Microsulfon) Sulfamethoxazole and Trimethoprim, (Bactrim, Septra) Sulfisoxazole, (Gantrisin) Sulfur and Sulfacetamide, (Nocosyn, Rosanil) Sulindac, (Clinoril, Nu-Sundac) Tenoxicam, (Dolmen, Mobiflex) Tetracycline, (Novo-Tetra, Sumycin) Tiaprofenic Acid, (DomTiaprofenic, Surgam) Tolazamide, (Tolinase) Tolbutamide, (Apo-Tolbutamide, Tol-Tab) Tolmetin, (Tolectin) Torsemide, (Demadex) Trandolapril, (Mavik) Trichlormethiazide, (Metatensin, Naqua) Valdecoxib, (Bextra) Xipamide, (Diurexan, Lumitens) Taking St. John's wort with these drugs may reduce blood levels of the drug: Amiodarone, (Cordarone, Pacerone) Digitalis, (Digitek, Lanoxin) Methadone, (Dolophine, Methadose) Taking St. John's wort with these drugs may be harmful: Acitretin, (Soriatane)—may increase the risk of unplanned pregnancy and birth defects. Carbamazepine, (Carbatrol, Tegretol)—may alter blood levels of the drug. Loperamide, (Diarr-EZ, Imodium A-D)—may increase the risk of confusion, agitation, disorientation, and other symptoms of delirium.
Lab Test Alterations:	May increase levels of growth hormone (somatotropin, GH). May decrease levels of serum prolactin. May decrease levels of theophylline. May decrease levels of serum iron. May decrease levels of digitalis. May decrease prothrombin time (PT) and plasma international normalized ratio (INR) in those who are also taking warfarin. May increase thyroid-stimulating hormone (TSH) levels.
Disease Effects:	May trigger psychosis in those with Alzheimer's disease or schizophrenia. May trigger mania or hypomania in those with bipolar disorder. May trigger hypomania in those with major depression.
Food Interactions:	Because of the possible monoamine oxidase inhibiting (MAOI) action of St. John's wort, limit intake of foods high in tyramine, such as aged cheese, red wine, bananas, aged or cured meat, and yeast-containing products.
Supplement Interactions:	May decrease therapeutic effects of digitalis. May increase positive and negative effects of herbs and supplements that have serotonergic properties, such as 5-hydroxytrytophan (5-HTP) and S-Adenosylmethionine (SAMe).
Warning:	Harmful if eaten. Skin allergen in sunlight. St. John's wort heightens the skin's sensitivity to the sun. Exposure to sunlight during a course of treatment with the plant may result in a skin rash or sunburn.
Bibliography:	Encyclopedia of Herbs by Deni Brown Copyright © 1995, 2001 Dorling Kindersley Limited. pg 240 The Essential Herb-Drug-Vitamin Interaction Guide by Geo. T. Grossberg,MD and Barry Fox,PhD Copyright©2007 Barry Fox,PhD. Pp.436-442 The Complete Guide to Natural Healing Copyright©1999 International Masters Publishers, AB Group 1 Card 63 Medicinal Plants.